2014-08-07T10:18:19-05:00 2013-09-30 061533253 SASLOW LUFKIN & BUGGY LLP 175 POWDER FOREST DRIVE SIMSBURY CT 06089 990 2012-10-01 060646599 DAY KIMBALL HEALTHCARE INC DAYK 8609286541 320 POMFRET STREET PUTNAM CT 06260 ROBERT SMANIK 8609286541 2014-08-05 1 BETH THURZ P00346435 8606789200 2012 2015-11-30 17:44:51Z DAY KIMBALL HOSPITAL ROBERT SMANIK 320 POMFRET STREET PUTNAM CT 06260 115519892 0 X WWW.DAYKIMBALL.ORG X 1894 CT SHORT-TERM GENERAL CARE HOSPITAL PROVIDING HEALTHCARE NEEDS TO THE NORTHEASTERN CT COMMUNITY. 15 11 1503 272 0 0 2554211 1669273 127208448 109135523 194664 161402 6156410 4470460 136113733 115436658 0 0 0 0 82458833 69228340 186168 0 0 51601424 48178460 134246425 117406800 1867308 -1970142 87880705 97043905 72081270 80958982 15799435 16084923 THE MISSION OF DAY KIMBALL HEALTHCARE IS TO MEET THE HEALTH NEEDS OF OUR COMMUNITY THROUGH OUR CORE VALUES OF CLINICAL QUALITY, CUSTOMER SERVICE, FISCAL RESPONSIBILITY AND LOCAL CONTROL. 0 0 93169288 107318263 DAY KIMBALL HEALTHCARE PROVIDES A COMPREHENSIVE HEALTHCARE SYSTEM OFFERING PRIMARY CARE AND A MULTITUDE OF MEDICAL AND SURGICAL SPECIALTIES ALONG WITH LEADING-EDGE TECHNOLOGY AND SOPHISTICATED DIAGNOSTICS. OUR SERVICE AREA INCLUDES NORTHEAST CONNECTICUT AS WELL AS NEARBY MASSACHUSETTS AND RHODE ISLAND COMMUNITIES. DAY KIMBALL HEALTHCARE'S COMPREHENSIVE NETWORK OFFERS MORE THAN 1,000 EMPLOYEES INCLUDING MORE THAN 200 HIGHLY-SKILLED PHYSICIANS, SURGEONS AND SPECIALISTS. 6782208 4486193 PHYSICIAN OFFICE PROVIDING PRIMARY CARE AND OUTPATIENT VISITS TO NORTHEASTERN CONNECTICUT COMMUNITIES. 99951496 1 1 0 1 0 0 0 0 0 1 1 1 0 0 1 1 0 1 0 0 0 0 0 0 1 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 0 0 1 139 0 1 1503 1 0 0 0 0 0 0 0 0 0 0 X 15 11 0 0 0 0 0 1 0 1 1 0 0 0 1 1 1 1 1 1 1 0 CT X STEPHEN BURKE 8609286541 320 POMFRET STREET PUTNAM CT 06260 MICHAEL BAUM MD 40.00 X X 369428 0 25400 ROBERT E SMANIK FACHE 40.00 2.00 X X 435841 0 37749 JOHN GRAHAM MD 1.00 X X 0 0 0 ROCHELLE ALIX 1.00 X X 0 0 0 GARFIELD DANENHOWER MD 1.00 X 0 0 0 RONALD FRANZINO MD 40.00 X 294965 0 22116 JOSEPH BOTTA MD 1.00 X 0 0 0 JOSEPH ALESSANDRO DO 1.00 1.00 X 57819 0 0 ATTY WILLIAM ST ONGE 1.00 X X 0 0 0 JACK BURKE 1.00 X X 0 0 0 KAREN A COLE 1.00 X 0 0 0 HADI BOZORGMANESH 1.00 X 0 0 0 JANICE THURLOW 1.00 X 0 0 0 SHAWN MCNERNEY 1.00 X 0 0 0 JOSEPH ADILETTA 1.00 X 0 0 0 WILLIAM JOHNSON 40.00 X 221644 0 21735 DOUGLAS WAITE MD 40.00 1.00 X 284545 0 28577 JULIE DROUIN 40.00 X 184496 0 27680 CHRISTINE VALLEE 40.00 X 150723 0 20103 CAROL HOWLAND 40.00 X 128957 0 19621 SARA BRANDON 40.00 X 120363 0 10480 DONALD ST ONGE 40.00 X 46414 0 1301 ERICA KESSELMAN MD 40.00 X 342532 0 29635 JOHN DAY MD 40.00 X 319672 0 37019 TIMOTHY MONAHAN 40.00 X 337639 0 9044 MANISH SAPRA 40.00 X 312539 0 21586 ANDREW MACKENZIE 40.00 X 392692 0 6731 JOHN P MILLER 40.00 X 121835 0 17377 4122104 0 336154 99 1 1 0 DOWNES CONSTRUCTION CO LLC 200 STANLEY STREET PO BOX 727 NEW BRITAIN CT 06050 CONSTRUCTION SERVICES 1744172 SOUTHWIND PO BOX 79461 BALTIMORE MD 21279 FINANCIAL CONSULTING 1130131 EASTERN CT HEMA & ONCOLOGY 330 WASHINGTON STREET SUITE 200 NORWICH CT 06360 PHYSICIAN SERVICES 779340 RDW GROUP INC 125 HOLDEN STREET PROVIDENCE RI 02908 ADVERTISING SERVICES 596181 SHEPLEY BULFINCH 2 SEAPORT LANE BOSTON MA 02210 INTERIOR DESIGN CONSULTING 451699 24 764654 904619 1669273 PATIENT SERVICE REVENUE 622110 104649330 104649330 PHYSICIAN OFFICE VISITS 621110 4486193 4486193 109135523 131086 131086 752331 0 752331 752331 752331 30316 0 30316 30316 30316 360820 83234 277586 277586 MISC PROGRAMS AND SERVICES 900099 2668933 2668933 CAFETERIA REVENUE 722210 656742 656742 PHARMACY REVENUE 446110 114868 114868 3440543 115436658 111804456 0 1962929 X 1688681 1445045 243636 50148270 42913198 7235072 5387021 4609818 777203 8223717 7037254 1186463 3780651 3235203 545448 672280 672280 143579 143579 19236 19236 12525422 10718334 1807088 606973 519403 87570 19493899 16681445 2812454 2564082 2194153 369929 2258198 1932400 325798 382738 327519 55219 45165 38649 6516 1021472 1021472 4669672 3995962 673710 1857929 1589879 268050 REPAIRS & MAINTENANCE 1566835 1340782 226053 RESTR CONTR EXPENDITURE 350980 350980 117406800 99951496 17455304 0 2185919 4773821 6927435 3263088 1666567 1246375 14415222 12870085 2205114 2148305 302092 492155 112069300 70769313 37024087 41299987 18874614 28043306 0 613449 4279655 2293334 87880705 97043905 15622563 16790150 30330000 17864874 1689909 38593833 32148923 72081270 80958982 X 5284743 7050300 6307797 4728936 4206895 4305687 15799435 16084923 87880705 97043905 X -1970142 252602 2003028 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 19236 19236 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: DAY KIMBALL HEALTHCARE, INC. PAID LOBBYING EXPENSES TO THE FOLLOWING ORGANIZATIONS: AMERICAN HOSPITAL ASSOCIATION IN THE AMOUNT OF $5,338 CONNECTICUT HOSPITAL ASSOCIATION IN THE AMOUNT OF $13,898 14006580 2046244 1177981 2779816 112027 14338962 11061361 1960237 1537535 464083 88470 14006580 9596540 1894638 -130663 529839 75932 10754744 9240275 382611 1054131 1017578 62899 9596540 12660714 500338 113264 299665 12974651 0.68640 0.10390 0.20970 0 0 3516235 3516235 66307167 44735949 21571218 31889736 26033364 5856372 10356162 10356162 41299987 INVESTMENTS IN REAL ESTATE 236356 C FUNDS HELD IN TRUST BY OTHERS 4538749 F FUNDS HELD UNDER BOND INDENTURE 9507142 F BOARD RESTRICTED ENDOWMENT FUNDS 10511560 F DONOR RESTRICTED ENDOWMENT FUNDS 3249499 F 28043306 PENSION LIABILITIES 31081416 DUE TO THIRD PARTIES 1067507 32148923 X 116516461 2055176 2055176 114461285 975373 975373 115436658 117406800 0 117406800 0 117406800 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: THE HOSPTIAL'S ENDOWMENT CONSISTS OF MULTIPLE FUNDS ESTABLISHED FOR A VARIETY OF PURPOSES INCLUDING CAPITAL EXPENDITURES, OPERATIONS, AND OTHER DONOR-SPECIFIED RESTRICTIONS. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: THE HOSPITAL ACCOUNTS FOR UNCERTAIN TAX POSITIONS IN ACCORDANCE WITH PROVISIONS OF FASB ASC 740, "INCOME TAXES" WHICH PROVIDES A FRAMEWORK FOR HOW COMPANIES SHOULD RECOGNIZE, MEASURE, PRESENT AND DISCLOSE UNCERTAIN TAX POSITIONS IN THEIR CONSOLIDATED FINANCIAL STATEMENTS. THE HOSPITAL MAY RECOGNIZE THE TAX BENEFIT FROM AN UNCERTAIN TAX POSITION ONLY IF IT IS MORE LIKELY THAN NOT THAT THE TAX POSITION WILL BE SUSTAINED ON EXAMINATION BY THE TAXING AUTHORITIES, BASED ON THE TECHNICAL MERITS OF THE POSITION. THE HOSPITAL DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS AS OF SEPTEMBER 30, 2013 AND 2012. AS OF SEPTEMBER 30, 2013 AND 2012, THE HOSPITAL DID NOT RECORD ANY PENALTIES OR INTEREST ASSOCIATED WITH UNCERTAIN TAX POSITIONS. THE HOSPITAL'S PRIOR THREE TAX YEARS ARE OPEN AND SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE. PART XI, LINE 2D - OTHER ADJUSTMENTS: ASSETS RELEASED FROM RESTRICTIONS FOR OPERATIONS 1,624,641. NON-OPERATING GAINS 430,535. PART XI, LINE 4B - OTHER ADJUSTMENTS: TEMPORARILY RESTRICTED CONTRIBUTIONS 975,373. GOLF TOURNAMENT 121381 121381 11118 6802 12948 15707 1731 DEARY ROAD RACE, WALK & RIDE 83508 83508 1711 525 8270 7 155931 155931 141 2956 9727 11598 360820 360820 12829 7468 15904 25434 21599 83234 277586 1 1 1 X 250.000000000000 0 1 1 1 0 0 360 324123 324123 0.00280 36234 19877850 19877850 0.16930 228707 209902 18805 0.00020 36594 20430680 209902 20220778 0.17230 18 3169 72871 17420 55451 0.00050 3 150 88855 88855 0.00080 1 0 94568 94568 0.00080 0 0 1 0 23 3319 256294 17420 238874 0.00210 23 39913 20686974 227322 20459652 0.17440 1 2073717 1185333 30526008 41033497 -10507489 X 1 1 1 1 DAY KIMBALL HEALTHCARE

320 POMFRET STREET PUTNAM CT 06260

X X X X DAY KIMBALL HEALTHCARE 1 1 X X X X X X X X 11 1 1 1 X X X X X X X X X 0 0 1 1 250.000000000000 0 1 X X X X X 1 1 X X X X X 1 X 0 1 X 0 0 16 PLAINFIELD HEALTHCARE CENTER

31 DOW ROAD / 12 LATHROP ROAD PLAINFIELD CT 06374

PRIMARY CARE; PEDIATRICS; WOMEN'S HEALTH; LABORATORY; DIAGNOSTIC IMAGING DANIELSON HEALTHCARE CENTER

55 GREEN HOLLOW ROAD DANIELSON CT 06239

DIAGNOSTIC IMAGING; LABORATORY; PHYSICAL MEDICINE SERVICES DANIELSON MEDICAL ASSOCIATES

45 GREEN HOLLOW ROAD DANIELSON CT 06239

PRIMARY CARE SERVICES PUTNAM SURGICAL ASSOCIATES

346 POMFRET STREET PUTNAM CT 06260

CONSULTATIVE AND SURGICAL SERVICES WOODSTOCK MEDICAL ASSOCIATES

168 ROUTE 171 SOUTH WOODSTOCK CT 06267

PRIMARY CARE SERVICES NORTHEAST CONNECTICUT DERMATOLOGY

55 GREEN HOLLOW ROAD DANIELSON CT 06239

DERMATOLOGY SERVICES MRI KENNEDY DRIVE

39 KENNEDY DRIVE PUTNAM CT 06260

MRI SERVICES BROOKLYN FAMILY MEDICAL ASSOCIATES

63 CANTERBURY ROAD BROOKLYN CT 06234

PRIMARY CARE SERVICES MEDICAL CENTER OF NORTHEAST CONNECTICUT

612 HARTFORD PIKE DAYVILLE CT 06241

GERIATRICS; INTERNAL MEDICINE; PULMONOLOGY SERVICES POMFRET STREET FAMILY MEDICAL ASSOCIATES

235 POMFRET STREET PUTNAM CT 06260

PRIMARY CARE SERVICES THOMPSON HEALTHCARE CENTER

415 RIVERSIDE DRIVE NORTH GROSVENORDALE CT 06255

PEDIATRIC CENTER CANTERBURY FAMILY MEDICAL ASSOCIATES

132 WESTMINISTER ROAD CANTERBURY CT 06331

PRIMARY CARE SERVICES THOMPSON FAMILY MEDICAL ASSOCIATES

415 RIVERSIDE DRIVE NORTH GROSVENORDALE CT 06255

PRIMARY CARE SERVICES DAYVILLE HEALTHCARE CENTER

11 DOG HILL ROAD DAYVILLE CT 06241

OB/GYN; DIABETES MANAGEMENT; GERIATRICS SERVICES SPORTS MEDICINE ASSOCIATES

55 GREEN HOLLOW ROAD DANIELSON CT 06239

SPORTS MEDICINE SERVICES PUTNAM HEALTHCARE CENTER

6-12 SOUTH MAIN STREET PUTNAM CT 06260

DURABLE MEDICAL EQUIPMENT SALES; PHYSICAL THERAPY; LAB DRAW PART I, LINE 3C: ANYONE WHO IS UNINSURED IS ELIGIBLE TO RECEIVE DISCOUNTED RATES REGARDLESS OF INCOME LEVEL. PART I, LINE 6A: DURING THE PRIOR TAX YEAR DAY KIMBALL HEALTHCARE COMPLETED A COMMUNITY NEEDS ASSESSMENT AND A COMMUNITY BENEFIT REPORT IN CONJUNCTION WITH THE WINDHAM COUNTY HEALTHCARE CONSORTIUM WHICH IS MADE UP OF WINDHAM HOSPITAL, DAY KIMBALL HEALTHCARE, NATCHAUG HOSPITAL, GENERATIONS FAMILY HEALTH CENTER, UNITED SERVICES, VNA EAST, NORTHEAST DISTRICT DEPARTMENT OF HEALTH AND COMMUNITY HEALTH RESOURCES (CHR). PART I, LINE 7: THE COSTING METHODOLOGY THAT WAS USED TO CALCULATE THE AMOUNTS REPORTED IN THE TABLE WAS DAY KIMBALL HEALTHCARE'S COST-TO-CHARGE RATIO THAT WAS REPORTED IN THE FY2013 MEDICARE COST REPORT. PART I, LINE 7G: DAY KIMBALL HEALTHCARE PARTNERS WITH NORTHEASTERN CONNECTICUT COUNCIL OF GOVERNMENTS (NECCOG) TO PROVIDE LOCAL PARAMEDIC INTERCEPT SERVICES. DAY KIMBALL HEALTHCARE AND NECCOG AGREED THAT THE ABSENCE OF PARAMEDIC INTERCEPT SERVICES IN NORTHEASTERN CONNECTICUT, COMPRISED OF MANY RURAL TOWNS, WOULD CREATE A SIGNIFICANT DEFICIENCY IN THE AVAILABILITY AND ACCESSIBILITY OF MEDICAL SERVICES IN THE COMMUNITY. THE HOSPITAL PROVIDES CERTAIN MONETARY AND IN-KIND SERVICES FOR THE PROVISION OF PARAMEDIC INTERCEPT SERVICES. PART III, LINE 4: PLEASE REFER TO THE ATTACHED AUDITED FINANCIAL STATEMENTS FOR NOTE 3 - REVENUES FROM SERVICES TO PATIENTS AND CHARITY CARE ON PAGE 11 THROUGH PAGE 13. PART III, LINE 8: THE SHORTFALL BETWEEN DAY KIMBALL HEALTHCARE'S MEDICARE COSTS AND PAYMENTS ARE CONSIDERED COMMUNITY BENEFIT BECAUSE THE SERVICES WERE PROVIDED BY DAY KIMBALL HEALTHCARE EVEN THOUGH THE COSTS WEREN'T COVERED OR REIMBURSED. THE COSTING METHODOLOGY USED TO DETERMINE THE AMOUNT REPORTED ON LINE 6 WAS GROSS CHARGES REDUCED BY THE COST TO CHARGE RATIO THAT WAS REPORTED IN THE FY2013 MEDICARE COST REPORT. PART III, LINE 9B: IT IS THE PHILOSOPHY AND POLICY OF DAY KIMBALL HEALTHCARE THAT MEDICALLY NECESSARY HEALTH CARE SERVICES SHOULD BE AVAILABLE TO ALL INDIVIDUALS REGARDLESS OF THEIR ABILITY TO PAY. THE POLICY HAS BEEN WRITTEN IN ACCORDANCE WITH SECTION 9007 OF THE PATIENT PROTECTION AND AFFORDABLE CARE ACT (ACT), SIGNED INTO LAW ON MARCH 23, 2010, WHICH ADDS NEW SECTIONS 501(R) AND 4959 TO THE INTERNAL REVENUE CODE. SECTION 501(R) INCLUDES A SERIES OF SPECIFIC REQUIREMENTS FOR HOSPITALS TO RECEIVE AND MAINTAIN SECTION 501(C)(3) ("TAX EXEMPT") STATUS. DAY KIMBALL HEALTHCARE PART V, SECTION B, LINE 3: DAY KIMBALL HEALTHCARE ALONG WITH THE OTHER MEMBERS OF THE WINDHAM COUNTY HEALTHCARE CONSORTIUM (WINDHAM HOSPITAL, DAY KIMBALL HEALTHCARE, NATCHAUG HOSPITAL, GENERATIONS FAMILY HEALTH CENTER, UNITED SERVICES, VNA EAST, NORTHEAST DISTRICT DEPARTMENT OF HEALTH AND COMMUNITY HEALTH RESOURCES (CHR)) UTILIZED THE CENTER FOR RESEARCH AND PUBLIC POLICY (CRPP), AN INDEPENDENT RESEARCH FIRM, TO CONDUCT A COMPREHENSIVE NEEDS ASSESSMENT UTILIZING FOCUS GROUPS AND PHONE SURVEYS OF COUNTY RESIDENTS ALONG WITH STATE AND FEDERAL DATA TO IDENTIFY AND PRIORITIZE THE HEALTHCARE NEEDS IN WINDHAM COUNTY. DAY KIMBALL HEALTHCARE PART V, SECTION B, LINE 4: DAY KIMBALL HEALTHCARE CONDUCTED ITS NEEDS ASSESSMENT IN CONJUCTION WITH THE WINDHAM COUNTY HEALTHCARE CONSORTIUM. THE MEMBERS OF THIS CONSORTIUM INCLUDE WINDHAM HOSPITAL, DAY KIMBALL HEALTHCARE, NATCHAUG HOSPITAL, GENERATIONS FAMILY HEALTH CENTER, UNITED SERVICES, VNA EAST, NORTHEAST DISTRICT DEPARTMENT OF HEALTH AND COMMUNITY HEALTH RESOURCES (CHR). DAY KIMBALL HEALTHCARE PART V, SECTION B, LINE 7: MOST OF THE HEALTH NEEDS IDENTIFIED IN THE ASSESSMENT ARE ALREADY ADDRESSED BY DAY KIMBALL HEALTHCARE, EITHER BY DIRECT DELIVERY OF SERVICE TO THE COMMUNITY OR THROUGH OUR COLLABORATIONS WITH SUCH ORGANIZATIONS AS HEALTHQUEST. THESE INCLUDE SERVICES AND PROGRAMS SUCH AS:- EXPANDING OF OUR INPATIENT AND OUTPATIENT BEHAVIORAL HEALTH SERVICES- PARTNERING WITH WHOLESOME WAVE, WIC AND THE LOCAL FARMER'S MARKET TO SUBSIDIZE MARKET COUPONS, DOUBLING THEIR VALUE, FOR FAMILIES WITH CHILDREN- WORKING WITH HEALTHQUEST AS AN ACTIVE MEMBER AND FUNDER ON SUCH PROGRAMS AS FOLLOW THE FIFTY, HEART HEALTH PROGRAM FOR WOMEN AND WRITE STEPS, AN ELEMENTARY SCHOOL-BASED WALKING AND WRITING PROGRAM TO IMPROVE HEALTH (IN PARTICULAR OBESITY IN CHILDREN) AND EDUCATION- BECOMING A SMOKE-FREE ORGANIZATION AND OFFERING SMOKING CESSATION CLASSES TO OUR EMPLOYEES AND CONTINUING TO OFFER CLASSES TO THE COMMUNITY- OFFERING DIABETES CARE MANAGEMENT SERVICES IN ALL OUR PRIMARY CARE OFFICES- IMPLEMENTING A SERIES OF COMMUNITY-BASED FLU SHOT CLINICS TO IMPROVE ACCESS- EXPANDING OUR SLEEP LAB WITH IN-HOME TESTING NOW AVAILABLE- CONDUCTING EDUCATIONAL SEMINARS ON COLON CANCER AND COLONOSCOPIES HOSTED BY OUR SPECIALTY TEAM OF PROVIDERSDAY KIMBALL HEALTHCARE'S STRATEGY INCLUDES THE ADOPTION OF A "MEDICAL HOME" SERVICE DELIVERY MODEL THROUGH THE ESTABLISHMENT OF A STRONG PRIMARY CARE PRATICE. ADDITIONALLY, WE ARE INTEGRATING OUR SERVICES ACROSS OUR MEDICAL NETWORK (DAY KIMBALL HOSPITAL, DAY KIMBALL HEALTHCARE CENTERS, DAY KIMBALL MEDICAL GROUP - OUR PHYSICIAN PRACTICES WHICH IS CURRENTLY TRANSITIONING TO THIS NOT-FOR-PROFIT FOUNDATION, DAY KIMBALL HOMECARE, DAY KIMBALL HOMEMAKERS, HOSPICE & PALLIATIVE CARE OF NORTHEASTERN CONNECTICUT) TO PROVIDE SEAMLESS CARE TO OUR PATIENTS. WE ARE IN THE PROCESS OF FORMALLY DOCUMENTING OUR STRATEGIC PLANNING AND IMPLEMENTATION PROCESS, AND WHILE WE DO TRACK OUR COMMUNITY BENEFIT PROGRAMS, WE HAVE NOT YET DONE SO IN RELATIONSHIP TO ADDRESSING THE HEALTH NEEDS OF THE COMMUNITY. DAY KIMBALL HEALTHCARE PART V, SECTION B, LINE 11: ANYONE WHO IS UNINSURED IS ELIGIBLE TO RECEIVE DISCOUNTED RATES REGARDLESS OF INCOME LEVEL. DAY KIMBALL HEALTHCARE PART V, SECTION B, LINE 20D: DAY KIMBALL HEALTHCARE USES A COST-TO-CHARGE RATIO TO DETERMINE THE MAXIMUM AMOUNTS THAT CAN BE CHARGED TO FAP-ELIGIBLE INDIVIDUALS FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE. PART VI, LINE 2: IN THE PREVIOUS TAX YEAR DAY KIMBALL HEALTHCARE COMPLETED A COMMUNITY NEEDS ASSESSMENT IN CONJUNCTION WITH THE WINDHAM COUNTY HEALTHCARE CONSORTIUM. THE CONSORTIUM UTILIZED A NATIONAL CONSULTING FIRM TO ASSIST IN THE PROCESS OF IDENTIFYING SPECIFIC HEALTH CARE NEEDS IN WINDHAM COUNTY. FOCUS GROUPS, TELEPHONE SURVEYS AND STATE AND FEDERAL DATA WAS USED TO IDENTIFY THE SPECIFIC HEALTH CARE NEEDS DURING THIS ASSESSMENT. PART VI, LINE 3: ALL PATIENTS WHO ARE UNINSURED ARE REFERRED TO THE FINANCIAL COUNSELING DEPARTMENT; INPATIENTS ARE ALL VISITED BY A FINANCIAL COUNSELOR (OR GIVEN A FINANCIAL COUNSELING PACKET) PRIOR TO DISCHARGE WITH ALL OF THE AVAILABLE PROGRAMS THAT ARE AVAILABLE THROUGH OUR FINANCIAL ASSISTANCE (CHARITY CARE) POLICY. ANY SCHEDULED PATIENTS WHO ARE UNINSURED ARE CALLED BY THE FINANCIAL COUNSELORS IN ADVANCE TO PROVIDE ALL OF THE OPTIONS INCLUDING SCREENING FOR MEDICAID ASSISTANCE, CHARITY CARE, AS WELL AS SEVERAL OTHER LOCAL FUNDING SOURCES THAT THEY MAY QUALIFY FOR. ALL PATIENT STATEMENTS HAVE INFORMATION ABOUT OUR CHARITY CARE POLICY AS WELL AS A DOWNLOADABLE CHARITY CARE APPLICATION. ALL OF OUR THIRD PARTY VENDORS, INCLUDING OUR BAD DEBT AGENCIES AND OUR LONG TERM PATIENT FINANCING PROGRAM THROUGH CAREPAYMENT ALSO PROVIDE OUR CHARITY CARE POLICY TO PATIENTS UPON REQUEST. OUR FINANCIAL ASSISTANCE GUIDELINES ARE ALSO POSTED IN ALL PATIENT REGISTRATION AREAS OF THE HOSPITAL. PART VI, LINE 4: DAY KIMBALL HEALTHCARE'S PRIMARY SERVICE AREA CONSISTS OF 13 TOWNS IN THE NORTHEASTERN CORNER OF CONNECTICUT AS WELL AS BORDERING MASSACHUSETTS AND RHODE ISLAND TOWNS. DAY KIMBALL'S SERVICE AREA IS OVER 438 SQUARE MILES AND CONTAINS APPROXIMATELY 117,604 IN WINDHAM COUNTY. THE POPULATION RANGES FROM LONG-TERM, MULTI-GENERATIONAL FAMILIES TO NEWLY IMMIGRATED RESIDENTS FROM URBAN AREAS. ACCORDING TO THE 2010 CENSUS, 11.7% OF THE POPULATION IS UNDER POVERTY LEVEL AND 14.3% ARE OVER AGE 65. THERE IS A WIDE RANGE OF SOCIO-ECONOMIC FACTORS INCLUDING VERY HIGH INCOME TO POVERTY; ADVANCED EDUCATION TO INCOMPLETE HIGH SCHOOL. THE MEDIAN HOUSEHOLD INCOME IN 2010 IN WINDHAM COUNTY WAS $58,489 (THE LOWEST INCOME OF ANY COUNTY IN THE STATE OF CONNECTICUT), WHILE THE STATE MEDIAN WAS $69,519. ACCORDING TO THE HEALTHY CONNECTICUT 2020 STATE HEALTH ASSESSMENT THAT WAS RELEASED IN MARCH 2014 THE LEADING CAUSES OF DEATH IN CONNECTICUT ARE HEART DISEASE AND CANCER. PART VI, LINE 5: THE MISSION OF DAY KIMBALL HEALTHCARE IS TO MEET THE HEALTH NEEDS OF OUR COMMUNITY THROUGH OUR CORE VALUES OF CLINICAL QUALITY, CUSTOMER SERVICE, FISCAL RESPONSIBILITY AND LOCAL CONTROL. DAY KIMBALL HEALTHCARE IS GOVERNED BY A BOARD OF DIRECTORS COMPRISED OF COMMUNITY MEMBERS AND PHYSICIANS. THE MEDICAL STAFF IS OPEN TO ALL PHYSICIANS IN THE COMMUNITY WHO MEET MEMBERSHIP AND CLINICAL PRIVILEGE REQUIREMENTS. INPATIENT, OUTPATIENT AND EMERGENCY SERVICES THAT ARE MEDICALLY NECESSARY ARE PROVIDED TO ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. PART VI, LINE 6: DAY KIMBALL HEALTHCARE HAS A RELATIONSHIP WITH UMASS MEMORIAL MEDICAL CENTER AS ITS TERTIARY CARE SITE. WHEN PATIENTS' CARE REQUIRES SPECIALIZED TREATMENTS, DAY KIMBALL COLLABORATES WITH PROMINENT MEDICAL CENTERS TO PROVIDE THE CARE THEY NEED. FOR INSTANCE, DAY KIMBALL PARTNERS WITH UMASS MEMORIAL MEDICAL CENTER IN WORCESTER, MA FOR CARDIAC CARE AND HAS DEVELOPED A SYSTEMATIC APPROACH TO STABILIZING AND TRANSPORTING HEART ATTACK PATIENTS TO UMASS FOR FURTHER TREATMENT. 0 1 0 0 0 0 0 0 0 MICHAEL BAUM MD 261399 0 94720 0 13309 0 7349 0 18051 0 394828 0 0 0 ROBERT E SMANIK FACHE 389880 0 12000 0 33961 0 21838 0 15911 0 473590 0 0 0 RONALD FRANZINO MD 261794 0 33171 0 0 0 7349 0 14767 0 317081 0 0 0 WILLIAM JOHNSON 197119 0 10125 0 14400 0 6217 0 15518 0 243379 0 0 0 DOUGLAS WAITE MD 284395 0 0 0 150 0 7336 0 21241 0 313122 0 0 0 JULIE DROUIN 184496 0 0 0 0 0 5577 0 22103 0 212176 0 0 0 CHRISTINE VALLEE 150723 0 0 0 0 0 4612 0 15491 0 170826 0 0 0 ERICA KESSELMAN MD 301231 0 0 0 41301 0 7237 0 22398 0 372167 0 0 0 JOHN DAY MD 319672 0 0 0 0 0 14668 0 22351 0 356691 0 0 0 TIMOTHY MONAHAN 299409 0 0 0 38230 0 7327 0 1717 0 346683 0 0 0 MANISH SAPRA 276092 0 36447 0 0 0 7373 0 14213 0 334125 0 0 0 ANDREW MACKENZIE 392692 0 0 0 0 0 6011 0 720 0 399423 0 0 0 JOHN P MILLER 121835 0 0 0 0 0 1967 0 15410 0 139212 0 0 0 PART I, LINE 4B ROBERT SMANIK, $33,961 PAYMENT RECEIVED FOR 457(F) PLAN, INCLUDED IN W-2 WAGES AS REPORTED ON THIS RETURN, WHICH INCLUDES A GROSS-UP FOR TAXES. A CHEFA SERIES B 060806186 20774YPC5 2013-06-06 30330000 EMERGENCY DEPARTMENT EXPANSION AND RENOVATION 0 0 0 A 15485409 30330000 2340522 1170295 606600 10723350 3824 2014 1 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 1 0 0 0 0 0 0 1 X 1 597925 COST X WIC VOUCHERS 1 756406 PROGRAM VOUCHERS 0 0 0 0 NON REPORTING OF REVENUE: PART I, LINE 33: NON-CASH CONTRIBUTIONS OF VACCINES AND WIC PROGRAM VOUCHERS WERE NOT INCLUDED AS REVENUE IN THE ORGANIZATION'S FINANCIAL STATEMENTS. FORM 990, PART VI, SECTION A, LINE 7A THE HOSPITAL HAS MORE THAN 400 CORPORATORS WHO ARE DEDICATED TO THE HOSPITAL'S MISSION. CORPORATORS ARE INDIVIDUALS INTERESTED IN THE PURPOSES OF THE HOSPITAL AND REPRESENT THE COMMUNITIES SERVED. CORPORATORS HAVE THE RIGHT TO PARTICIPATE IN THE ELECTION OF DIRECTORS AND OFFICERS. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS REVIEWED BY ROBERT SMANIK, PRESIDENT, AND STEPHEN BURKE, CORPORATE CONTROLLER, PRIOR TO FILING. A COPY OF THE 990 IS MADE AVAILABLE TO ALL BOARD MEMBERS. FORM 990, PART VI, SECTION B, LINE 12C EVERY JANUARY THE BOARD OF DIRECTORS ARE REQUIRED TO FILL OUT A CONFLICT OF POLICY DISCLOSURE FORM. IF ANY CHANGE IN THE FORM ARISES THROUGHOUT THE YEAR THEY ARE REQUIRED TO REPORT THE CHANGE PROMPTLY TO THE CHAIR OF THE BOARD OF DIRECTORS OR THE PRESIDENT OF DAY KIMBALL HEALTHCARE. FORM 990, PART VI, SECTION B, LINE 15 DAY KIMBALL HEALTHCARE PARTNERS WITH AN EXTERNAL CONSULTANT TO ANALYZE ALL LEVELS OF COMPENSATION WITHIN THE ORGANIZATION. THIS ENABLES US TO ENSURE THAT THERE IS A SOLID FRAMEWORK TO MAKE EFFECTIVE, CONSISTENT, STRATEGIC AND OPERATIONAL COMPENSATION DECISIONS THAT IMPACT OUR EMPLOYEES FOR THE SUPPORT THEY PROVIDE TO THE OVERALL MISSION AND STRATEGY OF DAY KIMBALL HEALTHCARE. ANY CHANGES THAT INVOLVE SIGNIFICANT FINANCIAL ADJUSTMENTS ARE PRESENTED TO THE BOARD OF DIRECTORS FOR APPROVAL. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. OTHER FEES FORM 990, PART IX, LINE 11G OTHER PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 10,718,334. MANAGEMENT AND GENERAL EXPENSES 1,807,088. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 12,525,422. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: ASSETS RELEASED FROM RESTRICTION 2,683,948. CHANGE IN PERMANENTLY RESTRICTED NET ASSETS 98,792. CHANGES IN TEMPORARILY RESTRICTED NET ASSETS -2,554,234. PENSION RELATED CHANGES OTHER THAN NET PERIODIC PENSION COST 9,148,079. NON-OPERATING GAINS 430,535. TRANSFER TO DAY KIMBALL MEDICAL GROUP -4,999,305. INVESTMENT IN DAY KIMBALL MEDICAL GROUP -2,804,787. FORM 990, PART XI, LINE 2C: THE FINANCE COMMITTEE OF THE BOARD HAS THE RESPONSIBILITY FOR THE SELECTION OF INDEPEDENT ACCOUNTANTS AND OVERSIGHT OF THE AUDIT OF THE ORGANIZATION'S FINANCIAL STATEMENTS. 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